scholarly journals Sex Moderates Treatment Effects of Integrated Collaborative Care for Comorbid Obesity and Depression: The RAINBOW RCT

2021 ◽  
Author(s):  
Nan Lv ◽  
Lan Xiao ◽  
Lisa G Rosas ◽  
Elizabeth M Venditti ◽  
Joshua M Smyth ◽  
...  
Keyword(s):  
Weight Loss ◽  
Collaborative Care ◽  
Treatment Effects ◽  
Logistic Models ◽  
Secondary Data ◽  
Integrated Treatment ◽  
Healthy Weight ◽  
Clinical Trial Registration ◽  
Clinically Significant

Abstract Background Sex influences health and related behaviors due to biological and psychosocial/socioeconomic factors. Assessing sex-specific responses to integrated treatment for comorbid obesity and depression could inform intervention targeting. Purpose To test (a) whether sex moderates the effects of integrated collaborative care on weight and depression outcomes through 24 months and (b) whether treatment response at 6 months predicts 12 and 24 month outcomes by sex. Methods Secondary data analyses on weight and depression severity (SCL-20) measured over 24 months among 409 adults with obesity and depression in the Research Aimed at Improving Both Mood and Weight trial. Results Men achieved significantly greater weight reductions in intervention versus usual care than women, whereas women achieved significantly greater percentage reductions in SCL-20 than men at both 12 and 24 months. In logistic models, at 80% specificity for correctly identifying participants not achieving clinically significant long-term outcomes, women who lost <3.0% weight and men who lost <4.1% weight at 6 months had ≥84% probability of not meeting 5% weight loss at 24 months. Similarly, at 80% specificity, women who reduced SCL-20 by <39.5% and men who reduced by <53.0% at 6 months had ≥82% probability of not meeting 50% decrease in SCL-20 at 24 months. Conclusions Sex modified the integrated treatment effects for obesity and depression. Sex-specific responses at 6 months predicted clinically significant weight loss and depression outcomes through 24 months. Based on early responses, interventions may need to be tailored to address sex-specific barriers and facilitators to achieving healthy weight and depression outcomes at later time points. Clinical Trial Registration NCT02246413 (https://clinicaltrials.gov/ct2/show/NCT02246413).

Abstract P222: Sex Moderates Treatment Effects in Integrated Behavior Therapy for Comorbid Obesity and Depression

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Nan Lv ◽  
Lan Xiao ◽  
Lisa Goldman Rosas ◽  
Elizabeth Venditti ◽  
Mark Snowden ◽  
...  
Keyword(s):  
Weight Loss ◽  
Usual Care ◽  
Collaborative Care ◽  
Treatment Effects ◽  
Logistic Models ◽  
Significant Weight Loss ◽  
Short Term ◽  
Short Term Treatment ◽  
Care Intervention ◽  
Clinically Significant

Introduction: Obesity and depression often co-occur, especially in women. Efficacious treatments exist for both conditions, but treatment outcomes vary. Assessing sex-specific responses to integrated therapy of these conditions could inform opportunities for tailoring. Hypothesis: Sex will significantly moderate the effects of an integrated collaborative care intervention on weight loss and depression outcomes through 24 months. Short-term treatment response at 6 months will reliably predict 12- and 24-month outcomes by sex. Methods: We conducted secondary analyses using data from the RAINBOW trial, which demonstrated efficacy of an integrated collaborative care intervention at reducing weight (BMI) and depression severity (SCL-20) at 12 months relative to usual care in adults with obesity and depression. Linear mixed models were used to assess treatment effects by sex, an a priori hypothesized biological moderator, on BMI and SCL-20 at 6, 12, and 24 months. Areas under the receiver operating characteristic curves (AUCs) based on logistic regressions were used to assess sex-specific thresholds of weight loss (%) and SCL-20 reduction at 6 months that reliably predicted clinically significant weight loss (i.e., ≥5% of baseline weight) and depression response (i.e., ≥50% decrease in SCL-20 scores) at 12 and 24 months. Results: Sex significantly moderated the treatment effects on BMI and SCL-20. Compared with women, men achieved significantly greater reductions in BMI at 6, 12, and 24 months in the intervention relative to usual care. Compared with men, women achieved significantly greater reductions in SCL-20 at 12 months only in the intervention relative to usual care. AUCs in the logistic models were similar for both sexes: >0.82 at 12 months and >0.65 at 24 months predicting clinically significant weight loss; >0.70 at 12 months and >0.67 at 24 months predicting clinically significant depression response. With 80% specificity to ensure good probability of correctly identifying participants not achieving longer-term outcomes of clinical significance, women who lost 2.5-3.0% weight and men who lost 3.4-4.1% weight at 6 months were likely to achieve ≥5% weight loss at 12 and 24 months. Similarly, women who reduced SCL-20 by 0.70 and men who reduced by 0.60-0.65 were likely to achieve ≥50% decrease in SCL-20 at 12 and 24 months. Conclusions: The treatment effects of this integrated intervention for obesity and depression differed significantly by sex, with men showing greater weight loss and women showing greater depression reduction. Sex-specific short-term responses at 6 months were identified for predicting clinically significant weight loss and depression outcomes at 12 and 24 months. Results suggest that sex may be an important tailoring variable when designing collaborative care interventions.

scholarly journals The Effects of If-Then Plans on Weight Loss: Results of the 24-Month Follow-up of the McGill CHIP Healthy Weight Program Randomized Controlled Trial

2019 ◽  
Author(s):  
Barbel Knauper ◽  
huma shireen ◽  
Kimberly Carriere ◽  
Mallory Frayn ◽  
Elena Ivanova ◽  
...  
Keyword(s):  
Weight Loss ◽  
Controlled Trial ◽  
Diabetes Prevention Program ◽  
Weight Loss Maintenance ◽  
Study Data ◽  
Average Weight ◽  
Healthy Weight ◽  
Clinically Significant

Abstract Background: The NIH-developed Diabetes Prevention Program (DPP) is successful in achieving clinically significant weight loss in individuals with overweight/obesity when delivered one-on-one. However, due to high cost of implementation, the long-term effectiveness remains limited. In response, a group-based version of the program, called the National DPP, was developed. The average weight loss following participation in this program was only about 3.5% with low long-term weight loss maintenance. Purpose: We aimed to optimize weight loss outcomes of the National DPP by integrating the habit formation tool of if-then plans into the program. Results at 3 and 12 months of participation showed no between-group differences between standard and enhanced DPP but higher weight loss in both groups compared to the National DPP. This paper reports the long-term weight loss maintenance data following participation in the program. Methods: Of the 172 participants enrolled at the beginning of the study, data from 110 participants was available and analyzed at 24 months, i.e. 12 months following the end of the 12-month intervention. Results: No between-group difference in weight loss maintenance was seen. Pooled results showed a significant weight regain from 12 to 24 months, i.e. an average of 7.85lbs of the 20.36lbs lost. However, participants from both groups were still 12.51lbs or 6.13% lighter at 24 months than at baseline. Conclusion: If-then plans did not result in a higher percentage of weight loss at 24-month follow-up. However, at 24 months, both groups maintained a significant portion of the weight lost at the end of intervention.

scholarly journals The Effects of If-Then Plans on Weight Loss: Results of the 24-Month Follow-up of the McGill CHIP Healthy Weight Program Randomized Controlled Trial

2019 ◽  
Author(s):  
Barbel Knauper ◽  
Huma Shireen ◽  
Kimberly Carriere ◽  
Mallory Frayn ◽  
Elena Ivanova ◽  
...  
Keyword(s):  
Weight Loss ◽  
Controlled Trial ◽  
Diabetes Prevention Program ◽  
Weight Loss Maintenance ◽  
Study Data ◽  
Average Weight ◽  
Healthy Weight ◽  
Clinically Significant

Abstract Background: The NIH-developed Diabetes Prevention Program (DPP) is successful in achieving clinically significant weight loss in individuals with overweight/obesity when delivered one-on-one. However, due to high cost of implementation, the long-term effectiveness remains limited. In response, a group-based version of the program, called the National DPP, was developed. The average weight loss following participation in this program was only about 3.5% with low long-term weight loss maintenance. Purpose: We aimed to optimize weight loss outcomes of the National DPP by integrating the habit formation tool of if-then plans into the program. Results at 3 and 12 months of participation showed no between-group differences between standard and enhanced DPP but higher weight loss in both groups compared to the National DPP. This paper reports the long-term weight loss maintenance data following participation in the program. Methods: Of the 172 participants enrolled at the beginning of the study, data from 110 participants was available and analyzed at 24 months, i.e. 12 months following the end of the 12-month intervention. Results: No between-group difference in weight loss maintenance was seen. Pooled results showed a significant weight regain from 12 to 24 months, i.e. an average of 7.85lbs of the 20.36lbs lost. However, participants from both groups were still 12lbs or 6.13% lighter at 24 months than at baseline. Conclusion: If-then plans did not result in a higher percentage of weight loss at 24-month follow-up. However, at 24 months, both groups maintained a significant portion of the weight lost at the end of intervention.

scholarly journals Changes in Maternal Weight 5–10 Years after a First Delivery

2012 ◽  
Vol 8 (5) ◽  
pp. 513-519 ◽  
Author(s):  
Sarah E Britz ◽  
Kelly C McDermott ◽  
Christopher B Pierce ◽  
Joan L Blomquist ◽  
Victoria L Handa
Keyword(s):  
Weight Loss ◽  
Black Women ◽  
Reproductive Factors ◽  
Education History ◽  
Healthy Weight ◽  
Maternal Weight ◽  
History Of ◽  
The Difference ◽  
Self Administered Questionnaire

Aim: The objective of this study was to identify maternal, obstetrical and reproductive factors associated with long-term changes in maternal weight after delivery. Materials & methods: Participants were enrolled in a longitudinal cohort study of maternal health 5–10 years after childbirth. Data were obtained from obstetrical records and a self-administered questionnaire. Weight at the time of first delivery (5–10 years prior) was obtained retrospectively and each woman's weight at the time of her first delivery was compared with her current weight. Results: Among 948 women, obesity was associated with race, parity, education, history of diabetes and history of cesarean at the time of first delivery. On average, the difference between weight at the time of first delivery and weight 5–10 years later was −11 kg (11 kg weight loss). In a multivariate model, black race and diabetes were associated with significantly less weight loss. Cesarean delivery, parity and breastfeeding were not associated with changes in maternal weight. Conclusion: Black women and those with a history of diabetes may be appropriate targets for interventions that promote a long-term healthy weight after childbirth.

Long-Term Weight Loss Maintenance on a Nutrient-Dense, Plant-Rich (NDPR) Diet

2019 ◽  
Vol 1 (1) ◽  
Author(s):  
Deana M Ferreri ◽  
Joel Fuhrman ◽  
Michael D. Singer
Keyword(s):  
Weight Loss ◽  
Online Survey ◽  
Weight Regain ◽  
Weight Loss Maintenance ◽  
Healthy Weight ◽  
Health Goal ◽  
Public Health Goal ◽  
Insight Into ◽  
Lower Adherence

Background: Obesity increases risk of diabetes, heart disease and cancer; a healthy weight reduces these risks, however weight loss efforts are prone to failure. Developing methods to promote weight loss maintenance is an important public health goal. We report on weight loss maintenance in individuals who followed a nutrient-dense, plant-rich (NDPR) diet. NDPR guidelines focus on increasing micronutrient density and avoidance of processed, highly palatable foods. Methods: Patients of a private family medical practice and members of a NDPR diet internet community (2273) completed an online survey providing information on length of time following a NDPR diet and body weight at several time points. Results: In respondents with pre-diet BMI ≥ 25 who had been following a NDPR diet for at least 2 years, those who reported adhering to NDPR guidelines in at least 80% of meals lost significantly more weight than those reporting lower adherence. Weight lost during year 1 was maintained at 2 and 3 years, and in respondents with initial BMI in the obese range (≥ 30), those losses were significantly greater in respondents who reported at least 80% adherence compared to 50-79% (56 lb. vs. 34 lb.) at 3 years. Between 1 year and 3 years, a low rate (19%) of weight regain ( ≥ 5 lb.) was reported among respondents 80-100% adherent to NDPR guidelines. Conclusions: Weight loss and maintenance for a period of 3 years was observed in this self-selected group, and respondents who reported 80-100% adherence lost significantly more weight than those who reported 50-79% adherence to NDPR guidelines. Individuals achieved substantially greater weight loss than that commonly observed in weight loss intervention studies. An intervention study, which would provide further insight into the influence of the NDPR guidelines on weight loss and maintenance, is warranted.

scholarly journals Motivational profiles and change in physical activity during a weight loss intervention: a secondary data analysis

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Danielle M. Ostendorf ◽  
Sarah J. Schmiege ◽  
David E. Conroy ◽  
Suzanne Phelan ◽  
Angela D. Bryan ◽  
...  
Keyword(s):  
Physical Activity ◽  
Weight Loss ◽  
Latent Profile Analysis ◽  
Exercise Intervention ◽  
Weight Loss Intervention ◽  
Clinical Trial Registration ◽  
Supervised Exercise ◽  
Motivational Profile ◽  
Motivational Profiles

Abstract Background High levels of moderate-to-vigorous intensity physical activity (MVPA) are strongly associated with sustained weight loss, however the majority of adults are unsuccessful in maintaining high levels of MVPA long-term. Our goal was to identify profiles based on exercise motives, and examine the association between motivational profile and longitudinal changes in MVPA during a weight loss intervention. Methods Adults with overweight or obesity (n = 169, mean ± SE; age 39 ± 0.7 years, BMI 34.4 ± 0.3 kg/m2, 83% female) underwent an 18-month behavioral weight loss program, including 6 months of supervised exercise, followed by 6 months of unsupervised exercise. Participants self-reported behavioral regulations for exercise at baseline (BREQ-2). Latent profile analysis identified subgroups from external, introjected, identified, and intrinsic regulations measured at baseline. Mean differences in device-measured total MVPA were compared across motivational profiles at baseline, after 6 months of supervised exercise and after a subsequent 6 months of unsupervised exercise. Results Three motivational profiles emerged: high autonomous (high identified and intrinsic, low external regulations; n = 52), high combined (high scores on all exercise regulations; n = 25), and moderate combined (moderate scores on all exercise regulations; n = 92). Motivational profile was not associated with baseline level of MVPA or the increase in MVPA over the 6-month supervised exercise intervention (high autonomous: 21 ± 6 min/d; high combined: 20 ± 9 min/d; moderate combined: 33 ± 5 min/d; overall P > 0.05). However, during the transition from supervised to unsupervised exercise, MVPA decreased, on average, within all three profiles, but the high autonomous profile demonstrated the least attenuation in MVPA (− 3 ± 6 min/d) compared to the moderate combined profile (− 20 ± 5 min/d; P = 0.043). Conclusions Results were in alignment with the Self-Determination Theory. Adults motivated by autonomous reasons (value benefits of exercise, intrinsic enjoyment) may be more likely to sustain increases in MVPA once support is removed, whereas participants with moderate-to-high scores on all types of exercise regulations may need additional long-term support in order to sustain initial increases in MVPA. Clinical trial registration NCT01985568. Registered 24 October 2013.

scholarly journals The effects of if-then plans on weight loss: results of the 24-month follow-up of the McGill CHIP Healthy Weight Program randomized controlled trial

Trials ◽  
2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Bärbel Knäuper ◽  
◽  
Huma Shireen ◽  
Kimberly Carrière ◽  
Mallory Frayn ◽  
...  
Keyword(s):  
Physical Activity ◽  
Weight Loss ◽  
Controlled Trial ◽  
Weight Loss Maintenance ◽  
Current Evidence ◽  
Health Improvement ◽  
Average Weight ◽  
Healthy Weight

Abstract Background Current evidence suggests that some of the most effective weight loss approaches are changes in dietary and physical activity behaviors through lifestyle modification programs. The Group Lifestyle Balance (GLB) program is a group-based behavior modification program aimed at changing diet and physical activity for weight loss. It was developed to be more cost-effective and easier to disseminate than its individually administered parent program, the Diabetes Prevention Program (DPP). However, the average weight loss following participation in the GLB is only approximately 3.5%, with low long-term weight loss maintenance. Purpose We aimed to optimize the weight loss outcomes of the GLB to increase the efficacy already afforded by its cost-effectiveness and ease of dissemination. We did this by integrating the habit formation tool of if-then plans into the program. This program is called the enriched GLB or the McGill Comprehensive Health Improvement (CHIP) Healthy Weight Program. Results at 3 and 12 months of participation have already been published elsewhere. They showed no between-group differences between the standard and enriched GLB but higher weight loss in both groups compared to the DPP. This paper reports the long-term weight loss maintenance data following participation in the program. Methods Of the 172 participants enrolled at the beginning of the study, data from 110 participants were available and analyzed at 24 months, i.e., 12 months after the end of the 12-month intervention. Results No between-group difference in weight loss maintenance was observed. Pooled results showed a significant weight regain from 12 to 24 months, i.e., an average of 7.85 lbs. of the 20.36 lbs. lost. However, participants from both groups were still 12.51lbs or 6.13% lighter at 24 months than at baseline. Conclusion If-then plans did not result in a higher percentage of weight loss at 24-month follow-up compared to the standard GLB. However, at 24 months, both groups did show a maintenance of a significant portion of the weight lost at the end of intervention. Trial registration ClinicalTrials.gov Identifier: NCT02008435, registered 6 December 2013.

scholarly journals Healthy Weight for Life programme: Evaluating the practice and effectiveness of a weight loss maintenance programme in the private health insurance setting

2019 ◽  
Vol 7 ◽  
pp. 205031211987381 ◽  
Author(s):  
Bronwyn McGill ◽  
Blythe J O’Hara ◽  
Anne C Grunseit ◽  
Adrian Bauman ◽  
Luke Lawler ◽  
...  
Keyword(s):  
Weight Loss ◽  
Health Insurance ◽  
Service Provider ◽  
Private Health Insurance ◽  
Weight Loss Maintenance ◽  
Service Utilisation ◽  
Healthy Weight ◽  
Term Maintenance ◽  
Maintenance Programme

Background: Australian private health insurers are increasingly involved in the delivery of chronic disease management programmes to their members, recognising the importance of decreasing and managing lifestyle risk factors and the impact such factors have on health service utilisation. One such secondary prevention programme is the Healthy Weight for Life programme, an intensive weight loss and lifestyle modification programme that has been designed for overweight and obese private health insurance members in Australia. Together with the insurer, the Healthy Weight for Life service provider developed and implemented a long-term maintenance programme that supports participants who complete the Healthy Weight for Life programme to maintain the weight loss they achieved during the programme. Various studies have shown that evidence-based weight management programmes can be effective; however, the results may vary in different contexts. Objective: This article presents the evaluation rationale and framework designed to assess the process and impact of the long-term maintenance programme on weight loss maintenance, other health-related benefits and participants’ experience with the programme. Methods: The evaluation will comprise a number of inter-related sub-studies balancing evaluation of programme effectiveness and implementation. The maintenance programme presented a unique opportunity for researchers to partner with private health insurance and a service provider to assess a real-world programme in the under-researched area of weight loss maintenance in this setting and emphasises the importance of evaluating such programmes given the potential the private health insurance context has in the future delivery of health care.

scholarly journals Az együttműködés növelésének eszközei a testsúlykontrollban

2019 ◽  
Vol 160 (43) ◽  
pp. 1687-1697
Author(s):  
Edit Czeglédi
Keyword(s):  
Weight Loss ◽  
Transtheoretical Model ◽  
Behavioral Change ◽  
Weight Control ◽  
Health Risk Behaviors ◽  
Point Of View ◽  
Behavior Motivation ◽  
Health Related ◽  
Clinically Significant

Abstract: Long-term successful weight control poses a huge challenge to people who are overweight and treat them in the obesogenic environment. After reaching a clinically significant (5–10%) weight loss, the goal is to maintain the weight loss achieved. However, this requires virtually constant resistance to temptations and requires sustained effort in terms of dietary restriction and physical activity, which requires a strong motivational base. From the point of view of behavior, motivation is the probability that the patient starts, pursues, or persistently follows a strategy that triggers change, that is, in the case of obesity, is committed to health-related behaviors that support weight management and abandons health risk behaviors that hinders weight control efforts. The present study describes the transtheoretical model of behavioral change and provides examples of practical ways to increase motivation and adherence at all stages of behavioral change. All this can contribute to the work of primary care and outpatient care professionals in supporting weight loss patients with excess weight. Orv Hetil. 2019; 160(43): 1687–1697.

scholarly journals Health and appearance reasons for weight loss as predictors of long-term weight change

2018 ◽  
Vol 5 (2) ◽  
pp. 205510291881660 ◽  
Author(s):  
Joseph E Mroz ◽  
Carol H Pullen ◽  
Patricia A Hageman
Keyword(s):  
Weight Loss ◽  
Multilevel Modeling ◽  
Weight Change ◽  
Significant Weight Loss ◽  
Web Based ◽  
Intervention Failure ◽  
Clinically Significant ◽  
Negative Predictor

This study investigated whether women’s initial reasons (health, appearance to others, or appearance to self) for wanting to lose weight influenced their weight change over a 30-month web-based intervention. Multilevel modeling with 1416 observations revealed that only appearance in relation to one’s self was a significant (negative) predictor. Women highly motivated to lose weight to improve their appearance in relation to themselves gained weight at 30 months, whereas those not motivated for this reason achieved clinically significant weight loss. Results suggest examining participants’ initial reasons for weight loss as an important component of intervention failure or success.

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